Background: Chronic kidney disease (CKD) affects up to 1 in 5 veterans and is independently associated in a graded fashion with cardiovascular disease, death and poor quality of life (QOL). Sleep-disordered breathing (SDB) is also common among veterans and increases risk of cardiovascular disease, death and poor QOL. While SDB is highly prevalent among those with advanced CKD compared to the general population, to date no study has examined the effect of SDB on health outcomes in advanced CKD. Methods: We will perform the first prospective cohort study of veterans with advanced CKD in the North Florida/South Georgia Veterans Health System. Veterans between 4/1/2011 and 3/31/2012with advanced CKD will be invited to undergo baseline portable sleep study, questionnaires, and renal function measure. Veterans will be followed for 3 years to determine risk of CKD progression and reduced quality of life. We will also validate a standard SDB risk-assessment questionnaire for use among veterans with advanced CKD. Significance: The proposed research will greatly impact health outcomes for veterans with advanced CKD by potentially identifying a novel risk factor for progression to ESRD and poor QOL. In addition, this research will be the first to validate a simple to-use SDB-risk assessment tool in advanced CKD. This work will lead to future proposals that will 1) determine if SDB promotes progression of CKD and poor QOL in veterans with early to moderate CKD; 2) develop and implement guidelines for SDB screening of CKD patients, incorporating a simple to use SDB risk- assessment tool; and 3) determine the impact of implementing these guidelines on CKD progression and QOL at the local and national VA levels. As such, results of the proposed work will lay the foundation for research that stands to improve CKD-related outcomes for veterans with CKD and SDB. PUBLIC HEALTH RELEVANCE: Chronic kidney disease (CKD) is common among veterans and increases risk of heart disease, death and poor quality of life. Sleep-disordered breathing (SDB), a disorder that is also common in veterans and advanced CKD, may lead to end-stage renal disease and increase risk of death and poor quality of life. The research proposed in this application will determine whether SDB increases risk of end-stage renal disease and poor quality of life among veterans with advanced CKD. In addition, the investigators will determine whether a standard SDB risk-assessment questionnaire is valid in advanced CKD. Results of this study will inform future proposals to develop guidelines for screening of veterans with CKD for SDB and demonstrate the impact of this intervention on CKD progression and QOL at local and national VA levels.